Impact of peripheral artery disease on early and late outcomes of transcatheter aortic valve implantation in patients with severe aortic valve stenosis. (15th March 2018)

• Record Type: Journal Article
• Authors: Kim, Byung Gyu; Ko, Young-Guk; Hong, Sung-Jin; Ahn, Chul-Min; Kim, Jung-Sun; Kim, Byeong-Keuk; Choi, Donghoon; Jang, Yangsoo; Hong, Myeong-Ki; Lee, Seung Hyun; Lee, Sak; Chang, Byung-Chul
• Is Part Of: International journal of cardiology. Volume 255(2018)
• Page Start: 206
• Page End: 211
• Publication Date: 2018-03-15
• Subjects: Peripheral artery disease -- Transcatheter aortic valve implantation -- Aortic stenosis -- Clinical outcome; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.11.065
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aims: Peripheral artery disease (PAD) is frequently present in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis. This study assessed the impact of PAD on clinical outcome after TAVI. Methods: A total of 115 patients who underwent TAVI were evaluated retrospectively. Patients were divided into PAD and non-PAD groups, with PAD defined as stenosis ≥ 50% in lower extremity arteries. Immediate and late clinical outcomes were compared between the two groups. Results: PAD was present in 31.3% (36/115) of the patients undergoing TAVI. Compared to the non-PAD group, the PAD group had higher Society of Thoracic Surgeons' (STS) risk scores (8.83% ± 6.20% vs 6.23% ± 4.15%, p = 0.039) and more frequent diagnoses of diabetes (52.8% vs 30.4%, p = 0.021) and multi-vessel coronary artery disease (55.6% vs 29.1%, p = 0.007). The PAD group also had higher incidence of major vascular complication (11.1% vs 1.3%, p = 0.033), 30-day mortality (13.9% vs 1.3%, p < 0.001), and subsequent 1-year (30.6% vs 3.8%, p < 0.001) and 2-year (47.2% vs. 10.1%, p < 0.001) all-cause mortality. PAD was identified as an independent predictor of increased 1-year mortality (hazard ratio [HR] 8.65; 95% confidence interval [CI], 1.05–71.14, p = 0.045) after TAVI along with high STS score (HR 11.18, 95% CI 1.36–92.04, p = 0.025). Conclusions: Presence of PAD was significantly associated with increased rates of major vascular complications as well as immediate and late mortality in patients undergoing TAVI. Assessment of PAD before TAVI is essential to choose an access strategy and to predict clinical results. Highlights: Peripheral Artery Disease is common in transcatheter aortic valve implant patients. PAD was associated with major vascular complications in TAVI patients (p = 0.033). PAD was associated with immediate and late mortality in TAVI patients (p < 0.001). PAD was an independent predictor of 1-year mortality after TAVI (p = 0.025). Assessment of PAD before TAVI is essential to determine procedure and clinical outcome.